From the Department of Population Health, NYU School of Medicine (A.T.L., M.B., G.O.).
Departments of Epidemiology (O.P.A., T.L.M., J.N.B., P.M.), University of Alabama at Birmingham.
Hypertension. 2020 Nov;76(5):1600-1607. doi: 10.1161/HYPERTENSIONAHA.120.14836. Epub 2020 Sep 14.
Resistant hypertension, defined as blood pressure levels above goal while taking ≥3 classes of antihypertensive medication or ≥4 classes regardless of blood pressure level, is associated with increased cardiovascular disease risk. The 2018 American Heart Association Scientific Statement on Resistant Hypertension recommends healthy lifestyle habits and thiazide-like diuretics and mineralocorticoid receptor antagonists for adults with resistant hypertension. The term apparent treatment-resistant hypertension (aTRH) is used when pseudoresistance cannot be excluded. We estimated the use of healthy lifestyle factors and recommended antihypertensive medication classes among US Black adults with aTRH. Data were pooled for Black participants in the JHS (Jackson Heart Study) in 2009 to 2013 (n=2496) and the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) in 2013 to 2016 (n=3786). Outcomes included lifestyle factors (not smoking, not consuming alcohol, ≥75 minutes of vigorous-intensity or ≥150 minutes of moderate or vigorous physical activity per week, and body mass index <25 kg/m) and recommended antihypertensive medications (thiazide-like diuretics and mineralocorticoid receptor antagonists). Overall, 28.3% of participants who reported taking antihypertensive medication had aTRH. Among participants with aTRH, 14.5% and 1.2% had ideal levels of 3 and 4 of the lifestyle factors, respectively. Also, 5.9% of participants with aTRH reported taking a thiazide-like diuretic, and 9.8% reported taking a mineralocorticoid receptor antagonist. In conclusion, evidence-based lifestyle factors and recommended pharmacological treatment are underutilized in Black adults with aTRH. Increased use of lifestyle recommendations and antihypertensive medication classes specifically recommended for aTRH may improve blood pressure control and reduce cardiovascular disease-related morbidity and mortality among US Black adults. Graphic Abstract A graphic abstract is available for this article.
抗药性高血压，定义为服用≥3 种降压药物或≥4 种降压药物时血压水平仍高于目标值，与心血管疾病风险增加相关。2018 年美国心脏协会关于抗药性高血压的科学声明建议抗药性高血压患者采用健康的生活方式习惯和噻嗪类利尿剂及盐皮质激素受体拮抗剂。当不能排除假性抗药性时，使用术语“明显抗药性高血压（aTRH）”。我们估计了美国黑人成年人中 aTRH 患者使用健康生活方式因素和推荐的降压药物类别。2009 年至 2013 年 JHS（杰克逊心脏研究）的黑人参与者（n=2496）和 2013 年至 2016 年 REGARDS 研究（地理和种族差异导致中风的原因）的黑人参与者数据进行了合并（n=3786）。结果包括生活方式因素（不吸烟、不饮酒、每周进行≥75 分钟剧烈强度或≥150 分钟中等或剧烈强度体力活动、体重指数<25 kg/m2）和推荐的降压药物（噻嗪类利尿剂和盐皮质激素受体拮抗剂）。总体而言，报告服用降压药物的参与者中有 28.3%患有 aTRH。在患有 aTRH 的参与者中，分别有 14.5%和 1.2%的人具有 3 项和 4 项生活方式因素的理想水平。此外，5.9%的 aTRH 患者报告服用噻嗪类利尿剂，9.8%的患者报告服用盐皮质激素受体拮抗剂。结论，在患有 aTRH 的黑人成年人中，基于证据的生活方式因素和推荐的药物治疗方法未得到充分利用。增加对 aTRH 特别推荐的生活方式建议和降压药物类别的使用，可能会改善血压控制并降低美国黑人成年人的心血管疾病相关发病率和死亡率。
